Rare causes of leg ulceration

Cause	Appearance	Description
Tuberculosis
Pyoderma gangrenosum		Undermined edte Violaceous Necrotic ulcer with hypertrophic margins
Syphillis		Gumma or tertiary syphilis has typical punched-out ulcer Over anterior surface of lower leg and yellow coloured "wash leather" base Scalloped border
Arteriovenous fistulae		Ulcer distal to fistula Shallow indolent ulcers
Rheumatoid arthritis		Necrotising vasculitis Purpuric, haemorrhagic bullae
Squamous cell carcinoma		Rolled or raised edge Often sun damaged skin
Sickle cell disease		Small punched out ulcers Often over medial aspect of lower leg

Surgical Notes